Provider Demographics
NPI:1033902309
Name:CHOUINARD, KATHRYN MAE
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MAE
Last Name:CHOUINARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:TN
Mailing Address - Zip Code:38355-7611
Mailing Address - Country:US
Mailing Address - Phone:731-426-5554
Mailing Address - Fax:
Practice Address - Street 1:470 MALL BLVD STE D
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-1648
Practice Address - Country:US
Practice Address - Phone:731-259-9995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16435225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist